Medicaid Fee Schedule

For most services, Idaho Medicaid reimburses providers the lesser of the billed amount or the maximum allowable fee established by the Idaho Department of Health and Welfare Division of Medicaid, whichever is lower.

Reimbursement rates may change during the year without update to the Internet fee schedule information. See Reminders Section below for additional information.

Procedure Description — Description of the procedure. For additional details, refer to the most current CPT or HCPCS code books.

NOTE: A zero price does not mean it is not a covered service. It could be a manually priced service, or reimbursement is based on invoice. Refer to the General Information Section of your provider handbook for more information. This information can be found on the Idaho Fiscal Agent's website.

For more information, see Reminders below.

How to Search

The Fee Schedule list is searchable based on procedure code. To search:

Open the pdf version of the Numerical Fee Schedule in the right hand column.

Go to the tool bar and click the binoculars icon.

Enter procedure code you are looking for.

Click on Find Next.

Reminders

When using the fee schedule, remember:

Idaho Medicaid requires all providers to bill their usual and customary charge for services provided to Medicaid recipients. Therefore, providers should not use the fee schedule to set their rates. "Usual and customary charge" means the provider's charge for providing the same service to persons not eligible for Medicaid benefits.

If you find a code not listed, contact Molina Medicaid Solutions at 1 (866) 686-4272, for more information.

Any code listed may have a service limitation associated with it or need prior authorization from Medicaid or its designee. For more information, refer to your specific provider section in the provider handbookor contact Molina Medicaid Solutions at 1 (866) 686-4272.

Different areas of a provider's office, such as billing and medical services, may have different uses for fee schedule information. Share schedule and handbook information with appropriate staff.

Different areas of a provider's office, such as billing and medical services, may have different users for fee schedule information. Share schedule and handbook information with appropriate staff.

How to Obtain a Copy

Numerical List — Sorted by procedure code. Does not include State Only or Anesthesia codes.

1. Go to the section below titled CURRENT INFORMATION to open and print: